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Cholera Vaccinations

Cholera

Cholera is an acute diarrhoeal infection, caused by the bacteria Vibrio Cholerae. An estimated 1.3 million to 4 million causes of cholera occur per year with between 21,000 and 143,000 deaths. Outbreaks can occur in any world region, but are more prevalent in regions where access to clean water and sanitation is not available.

Transmission

Cholera is transmitted by drinking contaminated water or eating food contaminated by faeces, such as shellfish. Person to person contact can occur where there is poor hygiene.

Symptoms

The incubation period varies between 2 to 5 days, but symptoms can occur in hours. The majority of people infected with cholera do not have symptoms or have mild symptoms. However, they pass the bacteria in their faeces for up to 10 days and can spread the infection to others.

The symptoms of severe disease are sudden onset of profuse watery diarrhoea that can lead to death by severe dehydration and kidney failure. Untreated, the death rate is up to 50%, but with prompt and correct treatment, this fall to less than 1%.

Treatment

Cholera is an easily treatable disease. The prompt administration of oral re-hydration salts to replace lost fluids nearly always results in cure in mild to moderate cases. In especially severe cases, intravenous administration of fluids and antibiotics may be required to save the patient’s life.

Prevention

It is important to maintain food and water hygiene at all times while travelling, particularly so, if you are carrying out voluntary work or are in remote areas. The cholera vaccine is a safe and effective vaccine for those who are at increased risk of contracting this potentially life threatening illness.

Cholera Vaccination

Inclusions

The vaccine can be given to anyone over 2 years of age travelling to endemic areas or to an area where there is a current outbreak.

Vaccine Schedules

Age range

Vaccine Brand

Method of Administration

Number of doses

Interval Between doses

Booster Requirement

From 6 years of age onwards

Dukoral

Oral

2 doses

Minimum interval 1 week
Maximum interval 6 weeks

2 years after 2nd dose if continuing risk

2-6 years

Dukoral

Oral

3 doses

Minimum interval 1 week
Maximum interval 6 weeks

6 months after 3rd dose if further risk of disease

If an interval of more than 6 weeks has elapsed between doses, then the course needs to be restarted.

Exclusions

The cholera vaccine should not be given in the following cases:

Anyone under 2 years of age

If there is a history of previous allergic reaction to the vaccine or any of it’s components

If there is an acute illness affecting the gastrointestinal tract,, such as acute gastroenteritis

If there is an acute illness with fever (greater than 38.5 degrees Celsius)

Pregnancy

There is no data on the safety of the cholera vaccine in pregnancy. However, during a mass-vaccination campaign conducted in Zanzibar, 196 pregnant women had received at least one dose of of the cholera vaccine and there was no evidence of a harmful effect of during pregnancy. Therefore, the vaccine can be given if the risk of cholera is sufficiently high.

Breast Feeding

There is no data on safety of the cholera vaccine administered to breast feeding mothers. However, there have no demonstrated evidence of harm when inactivated vaccines are given to breast feeding mothers. Therefore, the vaccine can be given if the risk of cholera is sufficiently high.

Common Side Effects

Mild gastro-intestinal symptoms, such as abdominal pain, diarrhoea and nausea are the most commonly reported symptoms.

Less frequently, flu-like symptoms, rash and joint pains have occurred.

Interaction with Other Vaccines

The vaccine does not interact with other vaccines and can be given at the same time or at any time before or after the following vaccines:

Formaldehyde-used in the manufacturing process. Trace amounts may still be detectable in the vaccine

The vaccine does not contain latex, egg, thiomersal or gelatin.

2) Is the cholera vaccine infectious?

The vaccine contained dead bacteria and therefore, it cannot cause the disease in the vaccinated individual. The bacteria is not shed in the faeces of the vaccinated individual and thus, they are not infectious to others.

3) Does the cholera vaccine protect against traveller’s diarrhoea?

The vaccine can protect against one type of traveller’s diarrhoea caused by a strain of the bacteria, E. coli.

4) Can I have the vaccine is I have a condition causing poor immune system?

As an inactivated vaccine, it can be given to anyone with poor immune system due to disease or medications. However, the immune response to the vaccine will not be as effective and thus, general precautions must be observed.

5) What are the booster requirements for travellers at ongoing risk of infection?

After the initial course, a booster is required within 2 years (in those older than 6 years) or within 6 months (in those aged 2-6 years). It is not known if further booster doses are required. However, it is advised that if more than 2 years or 6 months has passed, then the initial course needs to be restarted.